Tag: mouth opening device

Introduction: Trismus is a painful condition in which there is restricted mouth opening. The purpose of this article is to help understand the lockjaw when going through treatment – surgery or radiation to the head and neck region.

Consequences of inadequate mouth opening (trismus)

1. Feeding – the person will have difficulty in taking large bites of food.
2. Difficulty in Chewing and Swallowing
3. Poor oral hygiene – oral cleaning is inadequate causing foul smell and inflammation in the mouth. Poor dental hygiene with increase risk of caries. Difficulty in doing any dental procedure.
4. Difficulty in speaking – some individuals find it difficult in communicating as they experience loss of words because of trismus
5. Tingling sensation and hypersensitivity to certain foods and spices.
6. Difficulty in the inspection of the oral cavity by self or by your doctor.
7. Difficulty in surgery or for any procedure in the oral cavity
8. Difficult anaesthesia – the endotracheal tube insertion may be difficult.

What is an adequate mouth opening?

The mouth opening of at least 3.5 cm measured between the front incisors (front teeth) of the upper and lower jaw. The range of mouth opening for a healthy individual would be 3.5 – 5.5 cms. The measurement can be done by TrisCaRe. Or for general purpose 4 vertical fingers or at least 3 vertically placed fingers can be put between the jaws.

Reasons for Trismus in patients for head and neck cancers –

1. In India, most patients already have Submucosal Fibrosis at present due to the regular use of tobacco and beetle (Areca) nuts.
2. Healing by Fibrosis – Following surgery of the oral cavity the healing is by fibrosis of the mucosa, flap, and muscles
3. Radiation – to the masticatory muscles especially the masseter and temporalis causes inflammation and heals by fibrosis.

The trismus can develop during treatment or even a long time after treatment. Once trismus develops it is quite difficult to treat. Preventive steps to be taken from the beginning.

Diagnosis and Grading

The diagnosis is based on the mouth opening of the person. The measurement is made between the front teeth of the upper and lower jaws. The measurement can be done with TrisCaRe which is an instrument with a measurement scale.

Grading of Trismus: Trismus was graded as:

Mild	Grade I	35 – 26mm
Moderate	Grade II	25 – 16mm
Severe	Grade III	15 – 0mm

PREVENTION

1. Preoperative assessment and intervention- Most patients with oral cancer would present with some degree of trismus. This is mostly due to the presence of associated submucosal fibrosis due to beetle nut and tobacco chewing. These patients would benefit from interventions at the beginning itself.
2. Patients planned surgery for the oral cavity are advised about trismus and preventive steps to be taken.
3. All patients for Radiation of the head and neck advised trismus care before the start of treatment.

What to do for treating Trismus?

1. Massage and Exercises of the oral cavity
2. Mechanical Stretching of the oral cavity
3. Posture management
4. Good Oral Hygiene

1.	Massage – The masseter muscles. Keep your fingers on the cheek palpate. Move your fingers in a circular fashion for 30-60 secs repeat 2-3 times a day.
	Exercise – Mouth opening – open your mouth fully till you feel a stretch, keep for 10 seconds
	Exercise – side movement -Right and left – Move your jaw to right hold for 3 seconds. Now move to the opposite side and hold for 3 secs.
	Exercise – Circular motion – Move your lower jaw in a circular motion first clockwise and then anticlockwise. Repeat this 3-5 times
2.	Mechanical Stretch – With TrisCaRe – keep the blades between the two jaws. Open slowly with the screw, till you can comfortably open. Now turn few more rounds on the screw and open it till you feel the stretch. Keep it for 30 secs. Repeat this 5 times per day
3.	Posture exercises – to keep your body straight and aligned.
	Neck stretch – Bend head backward and forward Bend head sideways right and left bringing ear to the shoulder Turn your head right and left side Maintain position in each position for 10 secs
	Head rotation – clockwise and anticlockwise – 5 times each
	Chin Tuck – Tuck your chin, pulling your head so that the ears line up with shoulders. Hold this position for 3 secs
	Shoulder exercises – up and down – pull your shoulder up and down keep in each position for 5 secs Shoulder rotation – backward and forwards in a circular motion each 5 times Shoulder push back – push both your shoulders backward to bring scapula (shoulder blades) together Hand raise- Raise your hand straight upwards and pull up. Maintain the position for 5 secs.
4.	Oral Hygiene – Maintain oral hygiene regularly – brush your teeth on waking up after every meal and before bed, gargle with non-alcoholic gargles 2-3 times daily, floss regularly. If you are using dentures remove and clean regularly, remove before going to bed

Self Oral Examination – at least once every month is a must. If you notice any changes and especially decreased mouth opening- do consult your doctor

Start early – if you notice decreased mouth opening during or after your treatment consult a doctor. A physiotherapist may help you with massages and exercise. Mechanical device TRISCaRe is an important adjunct device for all head and neck cancer patients undergoing treatment and would be needed to be used for a lifetime.

TrisCaRe by ICanCaRe – mechanical mouth opening device to stretch open the jaws. Mechanical Device (TRISCaRe) – TrisCaRe is the optimum device for jaw stretching. TrisCaRe is to be fitted between the upper and lower jaw and the blades are opened with the screw. Jaw stretching with a mechanical device is the only way one can ensure the mouth opening of a patient with trismus. Studies have shown that mechanical jaw stretching can increase mouth opening by 5-10 mm or more even in the severest form of trismus.

Cause – if it is due to tobacco and beetle nuts, the patient is referred to the Tobacco Cessation Intervention specialist to treat the patient for the tobacco disease. Call 011-43077695 or visit www. icancare.in/quit tobacco for assistance in quitting smoking and tobacco.

Conclusion –  Trismus may be acute(temporary) or chronic depending on the cause. Acute responds well to medications and exercises. The chronic long-standing needs long-term intervention with lifelong use of TrisCaRe. For all patients undergoing surgery or radiation for cancers early intervention with TrisCaRe is advised to avoid or reduce the permanent trismus. Early intervention helps for a better outcome.

(The Author – Dr. Pawan Gupta M.Ch. is Director of Surgical Oncology at Max Super Speciality Hospital, Vaishali. Patparganj and Noida. He is the author of the book – Win Over Tobacco Made Easy, Be Smart Do Not Start and is highly recognized for his work on Oral Cancer and Tobacco Cessation. He is the convenor for Certified Course in Tobacco Cessation under the Gujarat University)